Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019163 (hepatitis B)
 38,309 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A postal questionnaire survey of renal units, and an analytical study of surveillance data on acute hepatitis B were undertaken to discover the numbers of renal units (a) routinely immunizing staff and patients against hepatitis B and (b) with recent experience of managing patients with hepatitis B. Seventy-three (86%) of 85 units returned completed questionnaires. Most (63, 84%) of the responding units routinely immunized staff but only 4 (5%) routinely immunized patients. A third (25) of the units had treated at least one HBsAg-positive patient between 1987 and 1991, and 11 units had cared for at least one patient with acute hepatitis B. Units with recent experience of treating an HBsAg-positive patient were no more likely to immunize staff or patients than those without. Guidance on hepatitis B immunization of staff has generally been implemented by UK renal units; that on immunization of patients has not. Renal unit patients remain largely susceptible to hepatitis B and the potential for outbreaks remains. Renal units need further encouragement to implement fully guidance on immunization.
Nephrol Dial Transplant 1994
PMID:Hepatitis B immunization in UK renal units: failure to put policy into practice. 770 61

Renal transplantation of patients with previous or ongoing hepatitis B virus infection has been tempered with a concern that immunosuppression may lead to viral replication and progressive liver damage. However, renal transplantation as therapy for end-stage renal failure in these patients improves quality of life and reduces the risk of body fluid exposure to their carers. To assess the long-term outcome of renal transplantation in hepatitis-BsAg-positive patients a retrospective study was carried out on the patients transplanted in this unit since 1969. Seventy-six patients received 98 grafts up to December 1991; follow-up was available on 68. Thirty-one of the 68 patients died; the causes of death were infective 23, cardiovascular 6, liver failure 4, pancreatitis 2, aspiration 1, GI haemorrhage 1, and stopped therapy 1. Serological markers of hepatitis B virus infection did not correlate with outcome. The risk of developing liver failure after renal transplantation appears small in the hepatitis-BsAg-positive patients and no patient should be denied a renal transplant on the basis of serological tests.
Nephrol Dial Transplant 1994
PMID:Outcome of renal transplantation in hepatitis BsAg-positive patients. 781 99

The study was undertaken to evaluate the relationship between non-responsiveness to hepatitis B (HBV) vaccination in haemodialysed patients and HBs antigen (Ag) presentation and recognition depending on TCR/CD3 receptors expression. We have found that the cause of the blunted response to HBV vaccination is multifactorial and seems to be associated with the following: (1) A reduced number of TCR/CD3 antigen receptor complexes on freshly isolated uraemic CD4 T cells, especially in non-responders. (2) The blunted proliferative response of uraemic CD4 T cells isolated from non-responders and stimulated for 6 days by autologous monocytes presenting HBsAg was associated with the decreased density of the TCR/CD3 receptors. (3) Moreover, in uraemic non-responders the expression of adhesion and accessory molecules on monocytes (intercellular adhesion molecule-1/ICAM-1, HLA-DR/Ia/) was significantly decreased following the culture with autologous monocytes serving as HBsAg-presenting cells. CD4 molecules and lymphocyte function antigen-1 beta/LFA-1 beta/ on helper-inducer T cells were increased before and after the culture. (4) These findings were also associated with a diminished binding capacity of IL-1 beta and IL-6 to their receptors on helper-inducer T cells. (5) IL-2, IFN-gamma and IL-4 production was decreased in uraemic non-responders, especially after 72 h of the culture. (6) Inhibited proliferation of helper-inducer T cells in uraemic non-responders was only partially reversible in the presence of exogenous IL-1 beta, IL-6, IL-2 and IFN-gamma. (7) HLA typing of uraemic non-responders was associated with extended haplotype: HLA A1,B8,DR3,DR7,DQ2.
Nephrol Dial Transplant 1994
PMID:Non-responsiveness to hepatitis B vaccination in haemodialysis patients: association with impaired TCR/CD3 antigen receptor expression regulating co-stimulatory processes in antigen presentation and recognition. 791 Jun 75

Due to inadequate cadaveric and living related organ supply, many end-stage renal disease patients go to third-world countries for living unrelated (paid) kidney transplantation. Thirty-four patients who have had transplantations in two centres in India before coming to our centre for post-transplant care and follow-up are reported in this study. In the post-transplant phase at our centre, the mean follow-up period of the patients was 209.7 +/- 137.3 (range 6-450) days. Fourteen of them, having an uneventful course, were followed on an outpatient clinic basis. The rest of the patients were hospitalized because of the following surgical and/or medical complications, during admission: urinary fistula in two patients; lymphocele in three patients; urinary tract obstruction in two patients; decubitus ulcer in one patient; severe wound infection in one patient; subacute myocardial infarction in one patient; acute irreversible vascular rejection in two patients; urinary tract infection in two patients; pneumonia in two patients; congestive heart failure and severe electrolyte disturbance in two patients; post-transplant diabetes mellitus and ketoacidosis in one patient; cyclosporin nephrotoxicity in two patients; cyclosporin nephro-, hepato-, and neurotoxicity in one patient. Plasmodium falciparum malaria in three patients, generalized mucormycosis infection in one patient, and genitourinary aspergillosis in one patient were seen during the first month. Hepatitis B virus infection followed by chronic active hepatitis was diagnosed in two patients, 2 and 4 months after the operation; and Kaposi's sarcoma was noted in another two patients, 1 and 5 months after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephrol Dial Transplant 1994
PMID:Living unrelated (paid) kidney transplantation in Third-World countries: high risk of complications besides the ethical problem. 808 44

During the last 4 years the organ donor rate increased in Spain, from 14.3 donors per million population per year in 1989 to 22.6 in 1994. This could have been even greater, since we observed 25% of family refusal rate during this period. The average age of organ donors increased by 4 years during the last 2 years. At the same time a change in the cause was mainly cranial trauma, during the last year 46% of organ donors died due to cerebrovascular problems, and 45% due to trauma, including road traffic and other causes. Road accidents causing death have decreased by more than 20% since 1992 explaining such a change in donors characteristics. While the percentage positive for hepatitis B virus in the donor population has remained stable during last years (1.7%), the percentage of (hepatitis C virus-positive donors) increased from 1.7% to 2.7%. Six per cent of kidneys grafted in Spain during 1993 were obtained from donors with previous hypertensive problems. Current donors are older, more have concomitant problems, and most of them died due to cerebrovascular problems; thus we have to be very careful about possible influences of these factors on graft outcome, paying great attention to donor and organ maintenance, ischaemia times, the use of nephrotoxic drugs, etc. Such caution should be increased when considering organs at the limit of acceptance for transplantation.
Nephrol Dial Transplant 1995
PMID:Evolution of the characteristics of transplant donors in Spain. 852 75

The aim of the study was to analyse the influence of co-infection by hepatitis B virus (HBV) and hepatitis C virus (HCV) as compared with HCV infection alone in 1098 patients who received a kidney transplant between 1 January and 31 December 1991. At transplantation, the prevalence of anti-HCV antibodies was 21.40% (235/1098) while the prevalence of HBV infection was 9.85% (108/1096); 46 patients were co-infected with HBV and HCV, either 19.70% of HCV-infected patients and 42.60% of HBV-infected patients. Liver tests, galactose clearance and liver biopsy were compared in the 46 co-infected patients (HCV+HBV+) and in the 189 HCV-infected patients (HCV+HBV-). At the time of transplantation, cytolysis was present in 31.45% of HCV+HBV- patients (50/159) and in 40% of HCV+HBV- patients (16/40); cholestasis was present in 34.18% of HCV+HBV- patients (34/158) and 42.11% of HCV+HBV+ patients (16/38). At 6 months the incidence of biological abnormalities increased to 37% in HCV+HBV- patients (55/150) and to 52.5% in HCV+HBV+ patients (21/40), suggesting a more deleterious effect of the immunosuppressive therapy in the co-infected group. Over the course of transplantation, chronic hepatitis was present in 50% of HCV+HBV- patients and in 64.1% of HCV+HBV+ patients. Liver failure occurred in 7% of HCV+HBV- patients (12/156) and 17% of HCV+HBV+ patients (7/41). Galactose clearance was performed as a functional test in 68 patients: it was not significantly different in either group. Liver biopsy was performed in 108 patients at least once.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephrol Dial Transplant 1995
PMID:Co-infection by hepatitis B virus and hepatitis C virus in renal transplantation: morbidity and mortality in 1098 patients. 852 82

Antibody responses to currently recommended immunizations in pediatric patients on chronic peritoneal dialysis (CPD) have been measured and the results have been variable. Although the incidence of vaccine-preventable disease in pediatric CPD patients is not known, it appears that protection from these diseases may be reduced. The explanation for the abnormal response to vaccines might include lower seroconversion rates in these patients, with lower antibody titers or levels. Also a rapid decline of antibody levels or titers may occur as a consequence of continuous peritoneal dialysis. Specific vaccines that may result in a less than optimal response in pediatric CPD patients include hepatitis B virus, hemophilus influenza type b, measles, mumps, rubella and pneumococcal vaccine. Patients who receive these immunizations should be monitored closely. Increased vaccine dosage, reinforced vaccination schedules, as well as concomitantly administered adjuvant immuno-modulators may play an important role in more effective vaccination of pediatric CPD patients. It is important that vaccine response be monitored in these patients by measuring specific antibody titers or levels to ensure adequate protection from vaccine-preventable illness.
Adv Perit Dial 1995
PMID:Immunizations in children on PD: current guidelines and recommendations. 853 20

The purposes of this paper is to review the specific role of peritoneal dialysis (PD) in patients with liver disorders. We will pay attention to the confluence of liver diseases and situations for which chronic dialysis treatment is required. Hemodialysis (HD) and peritoneal membranes are safe barriers against the passage of the hepatitis C virus; consequently, while peritoneal effluent or HD ultrafiltrate drained from hepatitis B patients/carriers is infective, that from hepatitis C patients does not appear to present this risk. An important issue is horizontal transmission, which appears to occur with both viruses in HD units, and which is absent in peritoneal dialysis units. The incidence of hepatitis C among continuous ambulatory peritoneal dialysis (CAPD) patients is quite low, while it may reach almost 50%-60% of HD patients in some units. While hepatitis C transmission mechanisms are not completely understood and a vaccine is not available, PD provides some degree of protection when compared with HD, for and-stage renal disease patients. In summary, our experience and that of others, with a total of 19 PD-treated chronic liver disease patients, supports CAPD as the treatment of choice for cirrhotic patients with ascites who require chronic dialysis. Data on peritoneal diffusion of low molecular weight substances revealed a marked increase in most patients. The ultrafiltration capacity was clearly augmented with respect to noncirrhotic patients, making the use of hypertonic bags unnecessary. Hemodynamic tolerance was excellent. Complications and death were mainly related to liver disease complications. Spontaneous bacterial peritonitis (SBP), caused by gram-negative germs, is the most important complication directly related to ascites and may have some points in common with PD-related peritonitis. However, and in contrast to most PD peritonitis, two pathogenetic mechanisms have been suggested for SBP: (1) translocation of bacteria from the gut to the mesenteric lymph nodes, and (2) bacteremia in these patients is secondary to the general abnormal host defense mechanisms. Local factors such as intrahepatic shunting and the impairment of bactericidal activity in ascitic fluid favor the bacteria ascites. The hypothesis of a direct transmural contamination from bowel to ascitic fluid has been relegated to secondary bacterial peritonitis. Would cirrhotic patients with temporal or permanent renal function compromise benefit from peritoneal catheter placement and other PD practices to perform repetitive small ascitic drainages at home? Perhaps the time has arrived when hepatologists and PD nephrologists begin to work shoulder to shoulder in this particular field, as we have a common problem, the peritoneal cavity filled with fluid.
Perit Dial Int 1996
PMID:Peritoneal dialysis in liver disorders. 872 96

Our objective was to determine the prevalence of the antibody to hepatitis C (anti-HCV) in a population of end-stage renal failure patients on continuous peritoneal dialysis (CPD) and study the possible risk factors associated with anti-HCV seropositivity and seroconversion. A cross-sectional study included 155 adult patients enrolled in the CPD program in a single renal unit of a teaching hospital who were screened for anti-HCV by second-generation enzyme immunoassay, which was confirmed by recombinant immunoblot assay. Serum was also assayed for hepatitis B surface antigen (HBsAg). History of renal transplantation, blood transfusions, and exposure to hemodialysis was obtained from medical records. Ten of 155 patients (6.5%) in this study population were anti-HCV positive [anti-HCV(+)] and 11/155 (7.1%) were HBsAg positive; no patient was positive for both. All the anti-HCV(+) patients were on continuous ambulatory peritoneal dialysis (CAPD); no continuous cycling peritoneal dialysis (CCPD) patient was anti-HCV(+). Exposure to hemodialysis was a risk factor for anti-HCV seropositivity, with 7 out of 10 (70%) anti-HCV(+) patients having been on hemodialysis compared to 55/134 (41%) anti-HCV(-) (p < 0.05, Fisher's exact test). No difference was noted between anti-HCV(+) and anti-HCV(-) groups in relation to age, gender, duration on CPD, renal transplantation, or exposure to blood transfusions. Seroconversion occurred in only one patient after a mean observation period of 20 +/- 0.6 months. The prevalence of anti-HCV seropositivity in this population of CPD patients is 6.5%, and HBsAG 7.1%. Exposure to hemodialysis is a significant risk factor for development of anti-HCV seropositivity. Seroconversion rate appears to be low.
Perit Dial Int 1996
PMID:Hepatitis C antibodies in patients on peritoneal dialysis: prevalence and risk factors. 872 37

Rates of peritoneal dialysis-associated catheter infections and peritonitis were compared in continuous ambulatory peritoneal dialysis patients grouped on the basis of their response to hepatitis B vaccination with Engerix to assess the usefulness of vaccination in predicting patients at risk for peritonitis and catheter infections. Engerix was given intramuscularly in a dose of 40 micrograms at 0, 1, 2, and 6 months. Sixty-three percent (20/32) of patients developed hepatitis B surface antibodies (converters). Converters and nonconverters were not different in proportions of women, whites, diabetics, or Staphylococcus aureus nasal carriers; mean age and mean months on peritoneal dialysis were also not different. Overall, peritonitis (0.46/year vs 0.33/year) and catheter infection (0.53/year vs 0.54/year) rates were not different among converters and nonconverters, respectively. Nonconverters had higher S. aureus peritonitis rates (0.12/year vs 0.04/year, p < 0.05) but lower S. epidermidis peritonitis rates (0.03/year vs 0.18/year, p < 0.02). However, when the patient with recurrent S. epidermidis peritonitis was excluded from analysis, S. epidermidis peritonitis rates among converters and nonconverters were not different (0.13/year vs 0.03/year, respectively, p < 0.09). These data suggest that the development of surface antibodies with hepatitis B vaccination does not predict a reduced risk of S. epidermidis peritonitis. The possibility that nonconverters are more likely to be S. aureus nasal carriers and therefore at greater risk of S. aureus peritonitis deserves further study.
Adv Perit Dial 1996
PMID:Does the response to hepatitis B vaccination predict CAPD-associated infections? 886 7


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